Birth Control What's new and what's in the news

Have you heard about new methods of contraception that recently became available in Canada? Have you read reports that some birth control methods may carry a higher risk? If you have questions about contraception, a visit to your family doctor is a great way to find out more. There, you can discuss what you have seen or heard and get reliable answers. Everyone is different, so choosing the right method of contraception is a very individual decision.

Your method of birth control will change from one stage of your life to the next. The best choice today may be different than what worked well for you last year, or for another woman you know.

What’s new in Canada?

Two relatively new methods are the Evra™ contraceptive patch and the NuvaRing™ contraceptive ring. Like the birth control pill, these contraceptives contain the two female hormones, estrogen and progesterone. Once in a woman’s blood stream, the hormones prevent ovulation (the release of an egg from the ovary). They also regulate monthly cycles of bleeding, or periods.

The main difference between pills, patch and ring involves how hormones enter the blood stream.

With the pill, hormones are absorbed through the digestive system. They immediately pass through the liver, where some are quickly destroyed. Hormones that make it through then circulate in the body. There is no ovulation and no pregnancy, and periods become regular. The amount of hormones in one pill only lasts a day. Another pill must be taken to continue the effect.

When a contraceptive patch is applied to the skin, hormones are absorbed from the membrane of the patch into the skin. They are then picked up by the blood stream and circulated through the body. This way, no hormones are lost in the ‘first pass’ through the liver. There are enough hormones in one patch to last for one week. Then the next patch much be applied to continue the effects.

With the contraceptive ring, a woman inserts the ring into her vagina (birth canal). The hormones released by the ring are absorbed straight through the lining of the vagina into her blood stream. Again, they circulate through the body and produce the desired effects of no ovulation and no pregnancy, plus regular periods. There are enough hormones in the ring to last for 21 days. Then the woman removes the ring for a one-week break before inserting a new ring.

With all three methods, the same hormones work in the same way. The only difference is in how they enter the body. The newer methods of patch and ring may be preferable to the pill for a number of reasons. Some women have trouble swallowing a pill or remembering to take it at the same time every day. Others experience side effects. For instance, the daily peak of hormones delivered by the pill can cause nausea. The ring and patch may not cause this problem, as they deliver a more constant level of hormones.

What’s in the news?

Recent studies into the safety of these newer contraceptives involve the more constant level of hormones delivered by the patch. Although patches place less hormones in the bloodstream than the pill does, there may be a higher risk of certain complications compared to the daily peaks and declines of the pill. The same will probably be true of the ring.

The main complication involved is a blood clot in the legs, also called deep vein thrombosis (DVT). It can sometimes travel to the lungs, where it is called a pulmonary embolus. This is a serious condition that can cause death.

DVT can happen to almost anyone, but it is generally very rare. Certain factors increase the risk of DVT, including smoking, staying still (such as after major surgery), leg injury, obesity, and pregnancy. Using any hormones, including a contraceptive pill, patch or ring, is also a factor. Women who use this kind of contraception and also smoke are most at risk.

In women with no other risk factors, the chance of DVT appears to be twice as high for those using the contraceptive patch rather than the pill. Having said that, the risk is still extremely rare, even for patch users. The contraceptive patch is probably not the right choice for women with risks of DVT. Otherwise, it is still an effective contraceptive that can be considered among all the other choices.

Another hot topic in the media involves using a hormone contraceptive to allow more than the usual four weeks between periods. New contraceptive products specifically designed to give women a period only every three months, or not at all, may soon be on the market. Some are very concerned about the safety and advisability of menstrual suppression.

However, menstruation is already being suppressed with the current hormone contraceptives. The bleeding that occurs monthly when a woman uses the pill, the patch or the ring is not a true menstrual bleed. The sudden withdrawal of all hormones causes this modified bleeding. It is no more or less healthy to go through this withdrawal bleed every three months instead of monthly. It can be considered a matter of personal preference.

If the idea of modifying your cycle this way interests you, discuss it with your family doctor. You can find out whether it is right for you and how it might be done using currently available contraceptive pills, the patch or a ring.

Contraception is an important part of most women’s lives from the teen years through menopause when fertility ends. It is complicated, since many personal and medical issues must be considered. Your method of birth control will change from one stage of your life to the next. The best choice today may be different than what worked well for you last year, or for another woman you know. Fortunately, Canadian women have many safe and effective contraceptives from which to choose.